Federal audit raps Colorado’s $10B Medicaid program for poor safeguards against fraud, abuse
State says just 5 percent of state’s Medicaid patients are in managed care plans
April 26, 2018
Colorado officials vowed to improve oversight of the managed-care portion of the state's $10 billion Medicaid program after a federal audit found poor safeguards against waste, fraud and abuse.
Federal regulators reviewed the state's supervision of managed care programs that subcontract with the Colorado Department of Health Care Policy and Financing to provide care to patients.
The audit by the federal Centers for Medicare and Medicaid Services reviewed Medicaid spending at three managed care programs in the state. The review found that from 2014 through 2016 those programs had recovered less than $65,000 in overpayments to doctors, psychologists and other health care professionals billing Medicaid. During those years, the programs conducted just 19 investigations into allegations of waste, fraud or abuse, an amount the auditors found "either low or nonexistent for a managed care program of Colorado's size."
The October 2017 audit found that Colorado has a "lack of effective policies and procedures" to guide how the programs should handle investigations, referrals and reporting requirements to the state when there are allegations of fraudulent Medicaid expenditures.